Healthcare Provider Details

I. General information

NPI: 1962314831
Provider Name (Legal Business Name): MS. MAITE DE LA CARIDAD MALVAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 NE 36TH TER
CAPE CORAL FL
33909-3245
US

IV. Provider business mailing address

2535 LIBERTY PARK DR APT 4308
CAPE CORAL FL
33909-3711
US

V. Phone/Fax

Practice location:
  • Phone: 239-214-4128
  • Fax: 239-214-2667
Mailing address:
  • Phone: 239-214-4128
  • Fax: 239-214-2667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI7599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: